By Dr David Laing Dawson
As much as we are sure Schizophrenia is a neurobiological illness, we remain unsure if it is a spectrum of disorders, or several different illnesses with different pathways to a similar syndrome. As Marvin pointed out recently, more than a century ago, Eugene Bleuler, who coined the term schizophrenia, thought of this illness as “the schizophrenias”, a spectrum of disorders.
In fully understanding and dissecting out the actual causes, both necessary and contributory, and the actual pathogenesis of the severe mental illnesses, we are decades behind our understanding of viral illnesses, heart disease, and cancer. There are reasons for this beyond the fact that the brain is a more complicated organ than the heart.
Emil Kraeplin, who, with Dr. Alzheimer, first described the disease we have come to know as Alzheimers, also studied the young people with persistent psychotic illness in his hospital. Relying on observations of behaviour he very accurately described the symptoms of what he called Dementia Praecox, and the course of the illness, as objectively as possible.
Unfortunately his observations were lost for many years under the onslaught of psychoanalysis and other mind-based theories, including Bleuler’s. In effect the objective observations of the behaviour and speech of schizophrenic patients was overshadowed by interpretations of these behaviours.
For example, some people with schizophrenia speak in a particular monotone, their speech devoid of many of the nuances of non-textual language (non-verbal) language that most of us use to modify, clarify, or even negate our actual text. Kraeplin described this. But Bleuler interpreted this as “blunted affect”. That is, he extrapolated from the observation of a communication difficulty to posit an “underlying emotional problem”.
Similarly Kraeplin described the way some of his patients, in mid sentence, might switch to a different apparently unrelated topic. Bleuler, logically but prematurely, extrapolated this to mean something was wrong with the way these patients formed their thinking, that their associations from one thought to another were differently based.
So for years after this, in the diagnosis of schizophrenia, we have clinicians looking for “blunted affect” and “loosened associations,” rather than, “a problem in contextual information processing” or “abnormal patterns of speech and semantic construction.”
A common and defining symptom of schizophrenia is the presence of delusional thinking. Yet some delusional people have an observable problem with contextual information processing and some don’t.
The second evolution that inhibited the development of our understanding of schizophrenia was, paradoxically, the accidental discovery of a medication that worked: chlorpromazine. Followed by other medications. Again, a natural line of inquiry and understanding opened up, this time extrapolating from the chemistry of the drug that works, back to the cause of the illness, and interest in more carefully defining, by observation, the symptoms of the illness(es) waned.
So in genetic research we are left trying to find a correlation between genetic differences and very poor, vague, delineations of syndromes.
It would be not dissimilar to seeking the genetic differences that lead to fever, fatigue, nausea, and sore joints.
It could be of immense help if we had better ways of defining, by observation, the specific pathways to the diagnosis of schizophrenia.
If you have a family member who suffers from schizophrenia, schizoaffective disorder or psychosis not otherwise specified, we would like to enlist your help in doing this by clicking on the following link and filling in the questionnaire. This will be anonymous and only take a few minutes. We are testing a hypothesis of five pathways to these diagnoses. If none of the descriptions fits your situation, please describe this, or the differences from the examples given.
If we can better define the different illnesses and pathways that result in a diagnosis of schizophrenia, we may be better able to find the underlying causes. We would appreciate your help in answering this simple questionnaire below.
Here is the survey. Your help is appreciated